Recommendations from the Trauma Steering Group highlight current inadequacies of Irish trauma services

Dr Conor Deasy, National Clinical lead of last week’s Major Trauma Audit Report 2016, highlighted that 28 per cent of patients last year needed to be transferred to another hospital because their required treatment could not be provided in the first hospital.

The National Office of Clinical Audit (NOCA) has welcomed this week’s publication of the report, which has emphasised the need for change in how trauma services are delivered.

Dr Deasy commended the work of the Trauma Steering Group, commenting: “Key investigations and management are currently being delayed, with only one-third of patients with head injuries requiring a CT scan receiving one within one-hour, in line with international best practice standards.

“Major Trauma Audit by NOCA will measure the effects of the changes in trauma care delivery on processes of care (for example seniority of doctors involved in trauma care, time to CT, theatre or an intensive care bed, access to rehabilitation etc) and outcomes (for example survival and quality of life of survivors)”.

He explained that the recommendations arising from the Trauma Steering Group need to be implemented so that a cohesive trauma system will be put into place in Ireland.

Currently, none of the 26 trauma receiving hospitals in Ireland meet international criteria to be designated as a major trauma centre and none receive the threshold volume of severely injured patients to maintain clinician’s skills in the delivery of care to this complex group of patients. The international experience from trauma networks in England, Wales and Australia tells us that, where trauma networks have been introduced, there will be a resulting 30 per cent increase in odds of survival.

The Irish Association for Emergency Medicine (IAEM) has also warmly welcomed publication of the report, claiming that the association has; “for many years, highlighted the urgent need to reform how trauma care is delivered to this small but very important subset of patients who sustain major life-threatening or life-changing injury.”

The IAEM highlighted how these suggested changes would ultimately benefit o the patient, their family and society, as getting the right patient to the appropriate people with the right skill set as early as possible would mean that the patient has the best chance of survival, a shorter recovery time, and a better chance of getting back to life as they knew it before their injury, saving lives and money.

The association outlined the situation as it stands for trauma patients currently: “Today, if you crash your car on Dublin’s M50 and sustain head, spinal, abdominal and bony injuries, you will be brought from the crash site to the nearest hospital. No one hospital in Dublin has all the trauma specialties on site – you will need to be transferred from the first hospital to the neurosurgical centre at Beaumont Hospital to have your brain bleed operated on; be moved from there to the Mater Misericordiae University Hospital to have your unstable spinal injury operated on and from there to Tallaght Hospital to have your fractured pelvis operated on and ultimately be moved from there to the National Rehabilitation Hospital in Dun Laoghaire for rehabilitation.

“The situation in rural Ireland is similarly inadequate. If you sustain the same constellation of injuries in Claremorris, for example, you will be brought to the Emergency Department in Mayo University Hospital. While you will be able to undergo emergency surgery there to stop bleeding from your abdominal organs, many vital hours will typically be lost before a bed is available at the neurosurgical or spinal centre and a team is available to transfer you.

“These hours make a difference to the likelihood of a good recovery. Already, a number of smaller hospitals have trauma by-pass protocols in place whereby ambulances will avoid bringing patients with obvious significant fractures to that hospital – this report supports further work towards ensuring that patients are triaged to the right hospital that has the right expertise available to manage that patient’s injuries”, the IAEM warned.

The fundamental philosophy of the Inclusive Trauma System model is that there would be a shared responsibility between the smaller hospital and the Trauma Service at the Major Trauma Centre to ensure a ‘push and pull’ approach exists to get the patient to the right care quickly. With the Major Trauma Centre, all trauma specialities would be on site at the hub so that if the patient’s needs exceed that which can be delivered at the Trauma Unit, Local Emergency Hospital or Injury Unit, the patient can be transferred without delay.